=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932103645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERYL LEE DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 SE 160TH AVE STE 121
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-8910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-253-3480
-----------------------------------------------------
Fax | 360-253-3484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 SE 160TH AVE STE 121
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-8910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-253-3480
-----------------------------------------------------
Fax | 360-253-3484
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE7945
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------